Forum Session

Managers

Summary

Population growth, the aging of the population, and expanded insurance coverage have raised concerns about a potential shortage of physicians to meet future demands for care. Discussions of a national shortage, however, overlook a possibly more immediate and important reality: there are two-fold differences across states in the number of practicing physicians per capita. While allopathic medical school capacity has expanded by 30 percent in response to shortage concerns, there has not been a commensurate increase in residency training positions which are required before medical school graduates can begin practicing. Calls have been made to lift the cap on Medicare-supported residency slots in place since the Balanced Budget Act of 1997. Proposals to lift the cap have also focused on what types (primary versus specialty care) and locations of residencies would be supported. The location of new residency programs affects the geographic distribution of physicians because physicians are likely to practice in the same area in which they trained as a resident.

This Forum session examined geographic disparities in physician supply, the effect of residency training location on practice location, the interest and abilities of hospitals to start or expand new residency programs, and state efforts to promote graduate medical education (GME). It also included a discussion of recently initiated residency programs and the challenges they faced.